Use of the Dorsal Vein of the Hand for Arteriovenous Fistula Creation

Utilization of the autologous vein on the ulnar side of the dorsal hand for arteriovenous fistula creation

We previously described the success and usefulness of two operative techniques for creating a radial artery-first or second dorsal metacarpal vein arteriovenous fistula (AVF) in the first interdigital space of the dorsal hand using the most distal site and autologous veins in the upper limb. These techniques utilize the dorsal metacarpal veins on the radial side of the dorsal hand. Developing these ideas, we devised a novel operative technique for creating a transposed radial artery-third metacarpal vein AVF in the first interdigital space of the dorsal hand using the most distal vein on the ulnar side of the upper limb and most distal site in the upper limb. The distinctive advantage of this technique is that it can be applied to patients whose cephalic vein in the forearm and the dorsal metacarpal veins on the radial side of the dorsal hand are of a poor quality. We herein report the steps of this technique and describe its successful performance in a patient who has been on hemodialysis for 14 months without any additional vascular access interventions or postoperative complications. We consider this technique to be a valuable option in select patients who meet the applicable conditions. The creation of the first AVF as distally as possible is ideal, and it offers a further viable option of distal native vascular access that may be overlooked.

Radial artery-second dorsal metacarpal vein arteriovenous fistula in the first interdigital space for hemodialysis: Utilization of the most peripheral site and autologous vein in the upper limb - A case report

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We describe a new operative technique for creating a radial artery-second dorsal metacarpal vein AVF in the first interdigital space for hemodialysis patients.

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This technique involves the creation of the AVF using the most peripheral site and autologous vein in the upper limb.

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This technique has several advantages including preserving many future VA options and providing a long segment of arterialized vein for cannulation.

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This technique is a worthwhile option in patients with the proper vessels for the creation of the AVF.

Introduction

The creation of the first arteriovenous fistula (AVF) as far distally in the upper limb as possible is ideal. We developed a new operative technique for creating a radial artery-second dorsal metacarpal vein AVF in the first interdigital space. This technique involves the creation of the AVF using the most peripheral site and autologous vein in the upper limb.

Case presentation

We herein describe the steps of this technique and its successful performance in a 71-year-old man with end-stage renal disease.

Discussion

This technique has several advantages including preserving many future vascular access options and providing a long segment of arterialized vein for cannulation.

Conclusion

We consider this technique to be a worthwhile option and recommend the use in patients with the proper vessels for the creation of the AVF.

Radial artery-first dorsal metacarpal vein arteriovenous fistula in the first interdigital space of the dorsal hand for hemodialysis

A radiocephalic arteriovenous fistula in the anatomical snuffbox (tabatière region) was first described in 1969 as the most peripheral site for arteriovenous fistula in the upper limb. In cases in which the internal diameter of the first dorsal metacarpal vein under avascularization is ⩾2.0 mm, we have adopted a new operative technique for creating a radial artery-first dorsal metacarpal vein arteriovenous fistula in the first interdigital space of the dorsal hand, which lies between the thumb and the index finger. This technique is the creation of the arteriovenous fistula using the first dorsal metacarpal vein and the most peripheral site in the upper limb. To our knowledge, no previous report has described the creation of a radial artery-first dorsal metacarpal vein arteriovenous fistula. We herein describe the steps of the technique and report its successful performance in a patient with chronic renal failure.